Everything You Should Know About Medical Billing and Coding

Medical billing and medical coding are two aspects in the revenue cycle management of healthcare providers which are very close to each other. Both practices are used in an important aspect like reimbursement cycles which means that the services that the healthcare provider is providing, will get the payment for that. 

To make you understand the two aspects in a detailed way, read the following article. This will help you to understand the two practices in the best way.

1. Medical Coding

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Medical coding fundamentally is just like a translation. The coder’s job is to take writing which is written in a way (doctor’s diagnosis, prescription) and translate them in the most possible accurate way into an alphanumeric code or numeric way. For each and every kind of injury, diagnosis, and medical procedure, each has a corresponding code.

In reality, there are numerous codes for an outpatient, medical procedure, and diagnosis. To understand it better, let’s take an example where coding is in action. 

A patient goes to a doctor’s chamber with say fever, cough, high mucus. A nurse in the doctor’s chamber enquires the patient about the symptoms and according to that performs some tests. The doctor then examines the test reports and prescribes the code to the patient accordingly. 

Each and every aspect which happens is either recorded by the doctor or by someone present in the clinic. The coder’s job is to translate each and every detail into alphanumeric codes or numeric ways so that they can be used during the medical billing process. 

In a medical code, there are numerous sets and subsets, but for now, the main two examples are International Classification of Diseases or ICD codes which corresponds to the patient’s sickness or injury, and Current Procedure Terminology or CPT which is used to translate each and every service that the provider provided to the patient. These codes are used as a universal language between hospitals, doctors, insurance providers, government agencies, and many other organizations which are health-related. 

First, the coder reads each and every report of the healthcare provider regarding the patient and then translates each and every detail into a code. Each and every kind of visit has its own specific code according to the symptoms. The doctors recommend different tests and thereby carry out the diagnosis that is suitable for the patient’s condition. The medical codes possess their own rules and guidelines which must be placed in a specific order. It is crucial that the medical coding gets done according to the proper guidelines that are present under the ICD-10 guidelines. 

2. Medical Billing

Medical billing when put in a layman’s term refers to the process of taking the relevant information from the coder which is used in making bills for the insurance payers known as medical claims. Of course, like any other aspect of the medical billing and coding program, there are many intricacies that are present within this. To understand the entire aspect of medical billing let’s take a look at the example that was used before. The same patient has come to the doctor where they are producing lots of mucus, has a fever, and is suffering from a cold. They call the doctor to schedule an appointment, just when they do that the process of medical billing gets initiated. 

The medical billing service provider then takes the respective codes that tally with the patient’s visit while taking into consideration the diagnosis the doctor has given the patient and the prescription. This helps in creating a medical claim with the help of medical software. The medical biller then sends this medical claim to the insurance company that assesses and returns the claim. The biller, therefore, assesses the claim that has been returned and finalizes the amount of money the patient owes after the medical insurance takes the required amount out. 

If the patient who is suffering from bronchitis has an insurance plan which covers the doctor’s visit along with the treatment for the medical condition, the bill will be relatively less since the majority of the amount is covered by the insurance company. If in any case the patient is unwilling or a delinquent when it comes to the payment of the medical bill, the biller can therefore hire a collection agency in order to ensure that the medical provider gets compensated in a fair manner.

The role of the medical biller is, therefore, to act as a waypoint between medical providers, patients, and insurance companies. To understand it in an easier manner, think of the medical coder and biller as a translator – where the medical coder has to translate each of the medical procedures into proper medical codes and the medical biller have to then translate these respective codes into a proper medical bill. Therefore, to produce a sound and proper financial report, both the medical coder and biller has to work hand-in-hand to ensure that there are no errors whatsoever. If, however, there is an error in any of the steps it can bring about a halt in the entire reimbursement process for the organization.

In order for your organization to achieve success and earn profits, it is imperative that you hire the best medical billing companies out there who can look after your needs and thereby fulfil all the necessary services your medical organization requires. A good medical billing and coding company will always look after your needs and ensure that there are no errors in the process o medical billing and coding. 

An experienced medical billing service provider like Synergy HCLS has well-trained staff and is well equipped with all the necessary software that is required for proper medical billing and coding which makes the process of reimbursement smoother.